It is well established that dissociative experiences are commonly reported by adults with borderline personality disorder (BPD) and differentiate them from adults with other psychiatric disorders. In contrast, dissociation in adolescents with BPD has not been well studied.
Researchers at McLean Hospital recently examined the overall severity of dissociation, the severity of the subtypes of dissociation, and predictive factors in adolescents with BPD and compared them with a cohort of adults with BPD who were assessed 17 years earlier.
In Borderline Personality Disorder and Emotion Dysregulation, they say the severities were similar in the two age groups, but the etiologies differed substantially.
The authors are Mary C. Zanarini, EdD, director of the Laboratory for the Study of Adult Development at McLean Hospital and principal investigator of the McLean Study of Adult Development, Eduardo Martinho Jr., MD, of the University of São Paulo, Brazil, and a trainer in generalist psychiatric management for BPD for the Gunderson Personality Disorders Institute at McLean, Garrett M. Fitzmaurice, ScD, director of the Psychiatric Biostatistics Laboratory at McLean, and colleagues.
Methods
As part of the McLean/Mount Sinai Study of Childhood Development (MSCAD), the researchers studied two cohorts of inpatients with BPD at those hospitals:
- 104 adolescents ages 13 to 17 who were admitted between August 2007 and September 2012
- 290 adults ages 18 to 35 who were admitted between June 1992 and December 1995
Each cohort participated in three diagnostic interviews:
- The Revised Diagnostic Interview for Borderlines (DIB-R, both age groups)
- The Structured Clinical Interview for DSM-IV Childhood Diagnoses (adolescents)
- The Childhood Interview for DSM-IV BPD (adolescents)
- The Structured Clinical Interview for DSM-III-R Axis I Disorders (adults)
- The Revised Diagnostic Interview for DSM-III-R Personality Disorders (adults)
Both cohorts also completed:
- The Dissociative Experiences Scale (DES)
- The Revised Childhood Experiences Questionnaire (CEQ-R), an interview which assesses four types of childhood adversity: childhood sexual abuse, three other forms of childhood abuse, seven forms of childhood neglect, and witness to violence
- The NEO Five-Factor Inventory, a 60-item self-report measure that yields scores of neuroticism, extraversion, openness, agreeableness, and conscientiousness
Severity of Dissociative Experiences
Adolescents and adults with BPD did not differ significantly in overall DES scores or the three DES subscores (absorption, depersonalization, and amnesia).
Furthermore, the different levels of dissociation (low, moderate, and high) were similar in adolescents and adults with BPD:
- Low levels (DES score <10)—35% of adolescents and 32% of adults
- Moderate levels (score 10 to 29.9)—47% and 42%
- High levels (score ≥30)—18% and 26%
Predictor Variables
To determine predictors of the severity of dissociation in BPD, the researchers considered 10 variables: the four types of childhood adversity measured in the CEQ-R, neuroticism, and five axis I disorders (mood disorders, substance use disorders, post-traumatic stress disorder, anxiety disorders, and eating disorders):
Adolescents
- Bivariate analysis – Severity of childhood neglect, neuroticism score, co-occurring substance use disorder, and co-occurring eating disorder (P<0.05 for all)
- Multivariate analysis – Co-occurring eating disorder (coefficient, 9.79; P=0.002)
Adults
- Bivariate analysis – Severity of all four forms of childhood adversity; co-occurring post-traumatic stress disorder (PTSD), anxiety, or eating disorder (P<0.01 for all)
- Multivariate analysis – Severity of childhood sexual abuse (coefficient, 2.39; P<0.001) and co-occurring PTSD (coefficient, 10.38; P<0.001)
Commentary
The similarity in severity of dissociation in adolescents and adults with BPD lends even more evidence to the validity of diagnosing BPD in adolescents as young as 13 to 17.
Another report from MSCAD, published in the Journal of Personality Disorders, noted a binge eating disorder in 21% of the adolescents with BPD and 28% of the adults, a non-significant difference. Several previous studies have found binge eating is strongly associated with the severity of dissociation in patients with eating disorders. That finding is not surprising, as binge eaters often report feelings of depersonalization and derealization.
It’s noteworthy that childhood sexual abuse and co-occurring PTSD were significant predictors of the severity of overall dissociation in the adult cohort and not the adolescent cohort.
The differences may be due, at least in part, to the fact that parents and society in general are far more vigilant about preventing sexual abuse of children than they were a generation or two ago.
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